BACKGROUND:Acute otitis media (AOM) is the leading cause of pediatric antibiotic prescribing, often with unnecessarily long treatment durations. This study evaluates the impact of clinical decision support (CDS) tools on pediatric AOM prescribing in ambulatory care settings. METHODS:This retrospective, quasi-experimental study evaluated the impact of (1) an electronic health record (EHR) order set with a preselected 5-day antibiotic duration for patients 2 years and older, and (2) an AOM clinical pathway on antibiotic prescribing for AOM. Review of patients 61 days to 18 years old presenting to emergency departments and urgent care centers within our institution between January 2019 and December 2023 was conducted. The primary outcome was the proportion of AOM encounters of children aged 2 to 18 years prescribed 5 days of antibiotics. The secondary outcome was the proportion of AOM encounters of children aged 61 days to 18 years prescribed enteral antibiotics or given ceftriaxone. Balancing measures included AOM-related revisits or complications. Interrupted time series segmented regression was used to analyze outcomes and balancing measures. Pathway use was assessed with a run chart, and order-set use was summarized descriptively. RESULTS:A total of 31 929 patients were included. The proportion of AOM encounters for patients aged 2 to 18 years old prescribed a 5-day antibiotic duration increased from 1% to 85% during the study period, with a significant immediate level increase of 55.21% (95% CI 48.82 to 61.6) after order set implementation. Antibiotic prescriptions remained high (88% to 93%). There were no increases in AOM-related revisits or complications. CONCLUSION:Implementation of an EHR order set with preselected antibiotic durations substantially reduced antibiotic exposure for pediatric AOM without an increase in complications or revisits.

BACKGROUND:There is substantial care variation for children with croup. Our primary aim was to describe variation in croup pathways by acute care setting and hospital type among sites participating in a national quality improvement (QI) collaborative-Better Assessment and Response to Croup in Kids (BARCK). METHODS:We conducted a cross-sectional study, consisting of site surveys to identify site characteristics and an independent review of croup clinical pathways by study physicians. Site application surveys were distributed via the Pediatric Acute and Critical Care and Quality Network listserv in September 2024, and a preproject survey was distributed between January and February 2025. Data were reported using frequencies and percentages. RESULTS:Of 107 participating sites, 96 (89.7%) completed surveys. Forty-eight (50.0%) sites indicated having a croup pathway, of which 30 (28.0% of participating sites, 62.5% with a croup pathway) were submitted and reviewed. Of 30 sites with croup pathways, 17 (56.7%) were classified as emergency departments (EDs) and 13 (43.3%) as mixed ED and urgent care (UC). Nine (52.9%) pathways from ED sites recommended ≥3 racemic epinephrine (RE) treatments before admission compared with 4 (30.8%) pathways from ED/UC sites. Few pathways from ED sites guided when to obtain a neck (23.5%) or chest radiograph (17.6%) compared with pathways from ED/UC sites (53.8% and 46.2%, respectively). Findings were similar when comparing by hospital type. CONCLUSIONS:There is considerable variation in croup pathways. The BARCK collaborative will provide an opportunity to standardize care practices across care settings.

Rapid treatment and frequent reassessment of pain are key components of treatment guidelines for acute sickle cell disease (SCD) pain. Few studies, however, report the associations between emergency department (ED) pain scores, number of ED opioid doses, receipt of an opioid prescription, ED visit disposition, or ED return visits. This seven-site retrospective cohort study analyzed 4983 ED visits by children with SCD pain using electronic health record data from the Pediatric Emergency Care Applied Research Network Registry. ED pain scores included initial, last, and change in scores (initial minus last), measured on a 0-10 scale. Dispositions of discharge and hospital admission were included. Modified Poisson regression and the Cochran-Armitage test of trend were used for analysis. The median (IQR) initial pain score was 8.0 (6-10); last pain score was 5.0 (2-8); and median decrease was 2.0 (0-5). In multivariable analysis, last pain score was the best predictor of disposition. For the return visit analyses, of the 2377 visits discharged at index ED visit, 29% returned within 14 days. Higher initial and last ED pain scores were associated with increased return visits. Children with no opioid discharge prescription and ≥3 ED opioid doses had a return visit rate of 36% compared to 22% if the child received an opioid prescription and only one ED opioid. Increasing discharge opioid prescriptions and targeting interventions for those who receive multiple ED opioid doses could decrease return visits.

Importance:Guidelines for the timely emergency department (ED) administration of opioids for acute sickle cell disease (SCD) pain lack clear evidence showing associations with reduced hospitalizations. Objective:To evaluate the associations between the timely administration of multiple opioid doses during uncomplicated SCD pain episodes in children and hospitalization. Design, Setting, and Participants:This multisite cross-sectional study used data from the Pediatric Emergency Care Applied Research Network Registry. Included were 12 pediatric EDs from children's hospitals with comprehensive SCD centers across the US. ED visits by children younger than 19 years with uncomplicated SCD pain at any of the 12 sites between January 1, 2019, and December 31, 2021, were included. Primary diagnosis codes were used to identify visits for SCD pain; visits with any other SCD complication were excluded. Initial data analysis was conducted from April 2024 to April 2025, including revisions. After-revision analyses were done between May and June of 2025. Exposures:The 2 exposures of interest were as follows: (1) time from ED arrival to first opioid administration (dichotomized as ≤60 minutes of arrival vs >60 minutes from arrival) and (2) time interval between the first and the second opioid administration (dichotomized in separate analyses as ≤30 minutes vs >30 minutes, ≤45 minutes vs >45 minutes, and ≤60 minutes vs >60 minutes). Main Outcomes and Measures:The primary outcome was hospitalization at the end of an ED visit. Results:A total of 2538 patients (mean [SD] age, 12.0 [5.0] years; 1293 male [50.9%]) were included in this study. Of 9233 ED visits, 5023 (54.4%) resulted in hospitalization. First-dose timeliness of opioid administration evaluated alone was associated with decreased hospitalizations (odds ratio [OR], 0.84; 95% CI, 0.75-0.95). Evaluating combined first- and second-dose timeliness of opioid administration for the 7853 visits (85.1%) with 2 or more opioid doses, first-opioid timeliness was associated with reduced odds of hospitalization, even when the second dose was outside 30 minutes (OR, 0.85; 95% CI, 0.74-0.98) or 45 minutes (OR, 0.84; 95% CI, 0.72-0.97). First-dose timeliness combined with a second dose within 30-minute (OR, 0.62; 95% CI, 0.52-0.75), 45-minute (OR, 0.70; 95% CI, 0.59-0.83), and 60-minute (OR, 0.78; 95% CI, 0.67-0.92) intervals achieved the lowest odds of hospitalization. Conclusions and Relevance:This cross-sectional study found that timely receipt of opioids was associated with a reduction in hospitalizations for SCD pain. The largest decrease in hospitalization was achieved with the first dose within 60 minutes and the second dose within 30 minutes; however, longer second-dose durations were associated with reduced hospitalizations.

Abstract Corresponding Author: Joana Dimo, DO, Department of Pediatrics, Division of Infectious Diseases, University of Colorado, 13123 East 16th Avenue, Box 055, Aurora, CO 80045, USA. 216-210-4687. joana.dimo@childrenscolorado.org Alternate Corresponding Author: Nicole M. Poole, MD, Department of Pediatrics, Division of Infectious Diseases, University of Colorado, 13123 East 16th Avenue, Box 055, Aurora, CO 80045, USA. (720) 777-7507. nicole.poole@childrenscolorado.org Funding: None No conflicts of interest Background Acute otitis media (AOM), the most common indication for pediatric antibiotics in the US, self-resolves without antibiotics in 60-75% of cases. This study evaluates the impact of a quality improvement intervention on antibiotic prescribing rate, first-line antibiotic choice, and treatment duration for pediatric AOM. Methods A bundled intervention for AOM management included (1) an electronic health record (EHR) order set that preselected a 5-day duration for children 24 months and older prescribed an antibiotic for AOM (April 2021) and (2) creation of a local clinical care pathway (CCP) for AOM (December 2022). The pathway encouraged observation and pain management in children 24 months and older with non- severe AOM, as well as children 6-23 months with unilateral, non-severe AOM. Non-severe AOM was defined as lack of severe otalgia following pain medication, temperature greater than 39☐C, and tympanic membrane perforation. A retrospective review of pediatric patients 61 days to 18 years old presenting to emergency and urgent care centers between January 2019 through September 2023 was conducted. Outcomes were (1) rates of antibiotic prescribing (oral or intramuscular formulations) over total AOM encounters in patients 61 days to 18 years old, (2) treatment duration of less than or equal to 5 days over all antibiotics prescribed (excluding azithromycin courses) in patients 24 months to 18 years old, and (3) first line antibiotic choice defined as amoxicillin over all antibiotics prescribed in patients 61 days to 18 years old. Statistical process control charts with upper and lower control limits and identified “special cause” variation by standard definitions were used to analyze outcomes. Results A total of 34,324 patients were included in the study. Rates of antibiotic prescribing remained high throughout the study time period (88 to 93%), with special cause variation detected (Figure 1). After EMR order-set development, a significant increase in compliance with recommended duration of less than or equal to 5 days was observed (3% to 83%), with special cause variation over the study period (Figure 2). Rates of amoxicillin prescribing versus non-first line antibiotic decreased throughout the study time (77 to 74%), with special cause decrease throughout the study (Figure 3). Conclusion Implementation of an EMR order set resulted in substantial increase in shorter durations for AOM in patients older than 24 months. Antibiotic prescribing rates increased, and amoxicillin prescribing decreased throughout study period. The effect of the amoxicillin shortage, which started in October 2022, likely played a role in amoxicillin prescribing rates, though increased use of amoxicillin with increasing supply has not yet been observed. This project indicated that further dissemination of the new AOM guideline and de-implementation of previous practices is needed to achieve improvement in antibiotic prescribing and first line antibiotic use. Figure 1: Proportion of antibiotics prescribed per all AOM diagnoses in patients 61 days to 18 years old. Figure 2: Proportion of patients with duration of 5 or fewer days compared to all duration in patients 2 years to 18 years old. Figure 3: Proportion of amoxicillin prescribed per all antibiotics in patients 61 days to 18 years old.

Introduction Reducing pain through prompt administration of pain medication in the emergency department (ED) is a primary driver of national guidelines for sickle cell disease (SCD), yet there are few data on how pain scores and changes in pain scores are associated with both the disposition at the initial visit and the likelihood of a return visit. In this study, we analyzed acute pain scores from ED visits for children with uncomplicated SCD pain crisis to determine the relationships between pain scores and disposition (admission or discharge) or occurrence of a return ED visit. Objectives For children with uncomplicated SCD pain crises, we aimed to determine (1) the association between initial pain score, last pain score, change in pain scores and the disposition of index ED visits, and (2) the association between these pain score values, number of parenteral opioid doses in the ED, whether an opioid prescription was provided at discharge, and an ED return visit within 14 days. Methods This is a multicenter retrospective cohort study of acute pain scores of ED visits by children for uncomplicated SCD pain crises. It was conducted using electronic health care data from the Pediatric Emergency Care Applied Research Network (PECARN) Registry across 7 sites (Lurie Children's, Children's Hospital of Philadelphia, Cincinnati Children's Hospital, Children's National Medical Center, Children's Colorado, Children's Wisconsin, and Nationwide Children's). Index ED visits were defined as uncomplicated pain crises with no preceding ED visits within 14 days between 01/2017 - 11/2021. We collected the following ED pain scores: initial, last, and change in scores (initial minus last) as measured by a numeric rating scale (0-10). For analyses related to disposition, we modeled the relationship between the three pain scores and hospital disposition adjusting for age, sex and uncomplicated pain crisis visit admission rate. For analyses related to return visits, we utilized the same predictor variables and added both the number of parenteral opioid doses administered in the ED and whether or not a prescription for an opioid was given at discharge. For all analyses, adjustment for site was made using generalized estimating equations with an exchangeable correlation structure to account for clustering within site. Modified Poisson regression was used to identify associations. SAS software version 9.4 was used for all statistical analyses. Results A total of 4,985 index visits for uncomplicated SCD pain crisis were included; 52% resulted in hospitalization. Overall, 39% of the children were <12 years old, 54% were female, and 96% were Black. Eligible index ED visits per site varied from 157 to 1855. The overall ED median (IQR) initial pain score was 8.0 (6.0-10).The median last pain score was 5.0 (2.0-8.0); median change in ED pain score was 2.0 (0.0-5.0). In univariate analyses, higher initial and last pain scores and a smaller change in pain scores were all associated with higher hospitalization rates. Adjusted rate ratios (95% CI) from multivariable models showed last pain score was the best predictor of admission 1.16 (1.12, 1.19), with change in pain score no longer significant 0.98 (0.96, 1.00). Examining percent of children hospitalized by last pain score shows over 80% of children with a last pain score of 7 or higher were hospitalized, compared to less than 40% if 4 or lower (Figure 1). 29% of the 2,377 visits that were originally discharged to home had a return visit within 14 days. None of the included pain scores from the initial visit (initial, last, or change) were associated with having a return visit within 14 days. However, both an increased number of ED opioid doses and failure to receive a prescription for an opioid at discharge were associated with increased return visits. Figure 2 shows the ED opioid doses and prescription for opioid combination and their respective return visit rates, with a high of 36% for ≥ 3 doses of ED opioid doses and no prescription and a low of 22% if 1 opioid given and a prescription at discharge. Conclusions: We found that for a child with SCD presenting to the ED with an uncomplicated pain crisis, the last ED pain score was a better predictor of hospitalization than initial or change in pain score. None of those pain scores predicted a return visit after discharge; however, fewer opioid doses in the ED and receipt of an opioid prescription at discharge were associated with fewer return visits.

ObjectiveEvaluate a nurse-initiated quality improvement (QI) intervention aimed at enhancing asthma treatment in a pediatric emergency department (ED), utilizing outcomes and workflow.MethodsWe evaluated the impact of QI interventions for pediatric patients presenting to the ED with asthma with pre-post analysis. A pediatric asthma score (PAS) of >8 indicated moderate to severe asthma. This secondary analysis of the electronic health record (EHR), evaluated on 1) patient outcomes (time to clinical treatment, ED length of stay [EDLOS], admissions and discharges home), 2) clinical workflow.ResultsWe compared 886 visits occurring between 01/01/2015 and 09/27/2015 (pre-implementation period) with 752 visits between 01/01/2016 and 09/27/2016 (post-implementation). Time to first documentation of PAS was decreased post-intervention (p<.001) by >30 min (75 +/- 57 to 39 +/- 54 min). There were significant decreases in time to treatment with both steroid and bronchodilator administration (both p<.001). EDLOS did not significantly change. Based on acuity level, those discharged home from the ED with high acuity (PAS score >= 8), had a significant decrease in time to initial PAS, steroid and bronchodilator use and EDLOS. Of those with high acuity who were admitted to the hospital, there was a difference pre- to post-implementation, in time to first PAS (p<.05), but not to treatment. Workflow visualization provided additional insights and detailed (task level) comparisons of the timing of ED activities.ConclusionsNurse-initiated ED interventions, can significantly improve the timeliness of pediatric asthma evaluation and treatment. Examining workflow along with the outcomes, can better inform QI evaluations and clinical management.

High return visit rates after hospitalization for people with sickle cell disease (SCD) have been previously established. Due to a lack of multicenter emergency department (ED) return visit rate data, the return visit rate following ED discharge for pediatric SCD pain treatment is currently unknown. A seven-site retrospective cohort study of discharged ED visits for pain by children with SCD was conducted using the Pediatric Emergency Care Applied Research Network Registry. Visits between January 2017 and November 2021 were identified using previously validated criteria. The primary outcome was the 14-day return visit rate, with 3- and 7-day rates also calculated. Modified Poisson regression was used to analyze associations for age, sex, initial hospitalization rate, and a visit during the COVID-19 pandemic with return visit rates. Of 2548 eligible ED visits, approximately 52% were patients less than 12 years old, 50% were female, and over 95% were non-Hispanic Black. The overall 14-day return visit rate was 29.1% (95% confidence interval [CI]: 27.4%–30.9%; site range 22.7%–31.7%); the 7- and 3-day return visit rates were 23.0% (95% CI: 21.3%–24.6%) and 16.7% (95% CI: 15.3%–18.2%), respectively. Younger children had slightly lower 14-day return visit rates (27.3% vs. 31.1%); there were no associations for site hospitalization rate, sex, and a visit occurring during the pandemic with 14-day returns. Nearly 30% of ED discharged visits after SCD pain treatment had a return visit within 14 days. Increased efforts are needed to identify causes for high ED return visit rates and ensure optimal ED and post-ED care.

BackgroundHigh return visit rates after hospitalization for people with sickle cell disease (SCD) have been previously established. Due to a lack of multicenter emergency department (ED) return visit rate data, the return visit rate following ED discharge for pediatric SCD pain treatment is currently unknown. ProcedureA seven-site retrospective cohort study of discharged ED visits for pain by children with SCD was conducted using the Pediatric Emergency Care Applied Research Network Registry. Visits between January 2017 and November 2021 were identified using previously validated criteria. The primary outcome was the 14-day return visit rate, with 3- and 7-day rates also calculated. Modified Poisson regression was used to analyze associations for age, sex, initial hospitalization rate, and a visit during the COVID-19 pandemic with return visit rates. ResultsOf 2548 eligible ED visits, approximately 52% were patients less than 12 years old, 50% were female, and over 95% were non-Hispanic Black. The overall 14-day return visit rate was 29.1% (95% confidence interval [CI]: 27.4%-30.9%; site range 22.7%-31.7%); the 7- and 3-day return visit rates were 23.0% (95% CI: 21.3%-24.6%) and 16.7% (95% CI: 15.3%-18.2%), respectively. Younger children had slightly lower 14-day return visit rates (27.3% vs. 31.1%); there were no associations for site hospitalization rate, sex, and a visit occurring during the pandemic with 14-day returns. ConclusionNearly 30% of ED discharged visits after SCD pain treatment had a return visit within 14 days. Increased efforts are needed to identify causes for high ED return visit rates and ensure optimal ED and post-ED care.

acute care setting based on common characteristics between cases. • Diagnostic error is a significant source of morbidity and mortality. • Identifying sources of diagnostic error and opportunities for healthcare improvement requires continuous case review. • However, no systematic approach to screening large volumes of patients for diagnostic error has been described in the pediatric acute care setting. • Cases for review were identified from the medical records of EDs and UC centers across the Children’s Hospital Colorado (CHCO) health system. • All patients who were seen at any CHCO ED/UC site between April 2018 and September 2018, discharged home, subsequently returned to care within seven days of initial visit, and were ultimately admitted to the hospital were included in the dataset. • Each case was reviewed by an interprofessional review team which included ED providers and registered nurses.

Introduction: Epinephrine is the only medication that prevents morbidity and mortality in anaphylaxis. Systemic corticosteroids and H2 receptor antagonists (H2RA) may benefit select cases but are not universally indicated. This study aims to de-implement the universal use of steroids and H2RAs and emphasize epinephrine-focused care for children with anaphylaxis during acute care visits. The study aims to reduce steroid and H2RA use from 81% and 60%, respectively, to 30% by December 2019. Methods: The primary outcome measures were the percent of patients receiving steroids and H2RAs in the emergency department (ED) or urgent care (UC). Process measure was the frequency of intravenous (IV) line placement. Balancing measures were ED/UC length of stay, admission rate, and ED/UC return visit rate. In addition, a multidisciplinary team designed the following interventions: (1) anaphylaxis clinical pathway to emphasize epinephrine-focused care, outline criteria for second-line therapies and a provider guideline for ED/UC observation; (2) standardize unit-based anaphylaxis medication kits; (3) optimize electronic medical record tools, including order sets and discharge instructions to be concordant with guideline recommendations. Results: The study included 870 patients. There was special cause variation in the use of steroids (81%-33%) and H2RAs (60%-11%), ED/UC Length of stay decreased (6.2-5.0 hours). There was no special cause variation in admission rates or ED/UC return visit rates. Conclusion: Universal use of systemic steroids and H2RAs can be safely de-implemented in pediatric patients with anaphylaxis using quality improvement methods.

Background and Purpose: Preventable adverse events lead to significant patient morbidity and mortality. Multiple factors associated with acute care delivery, including chaotic environment, shift work, frequent hand offs, and interruptions, may contribute to preventable adverse events. Consistent reporting and review of adverse events and near misses may help identify and correct underlying causes. Our objective was to create a sustainable and effective adverse event review system in pediatric emergency network system. We aimed to establish a sustainable (at least 80% of sessions with 4-12 cases) and effective (at least 1 action item per session) standardized Emergency Department (ED) and Urgent Care (UC) Case …

Introduction: Unscheduled return visits within 72 hours of discharge account for 4% of pediatric emergency department (ED) visits each year and are a quality indicator of ED care. This project aimed to reduce the unexpected 72-hour return visit rate for a network of ED and urgent cares (UC) by improving discharge processes. Methods: A multidisciplinary team conducted a quality improvement initiative in the EDs/UCs of a tertiary children’s hospital network. The team developed discharge interventions through successive Plan-Do-Study-Act cycles. They included standardization of the electronic health record discharge workflow and implementation of “mini-after care instructions” and teach-back education. The team used a statistical process control chart to follow the 72-hour return rate, and a chi-square test to compare the pre- and post-intervention 72-hour return rate. Results: The ED/UC network discharged 219,196 patients during the study, 12/2014–4/2016. The baseline 72-hour return rate was 3.5% before interventions. The team implemented discharge interventions from 12/14 to 9/15. After the implementation of mini-after care instructions (4/15), 8 consecutive points fell below the mean on the statistical process control chart, and there was an 8.2% reduction in the 72-hour return rate (P < 0.01). Admission rates of 72-hour return patients remained stable throughout the study (27% pre-intervention and 28% post-intervention). Improvements to the ED/UC discharge process resulted in the estimated prevention of 600 ED/UC visits annually throughout the network. Conclusions: Quality improvement methodology and multidisciplinary enhancement of discharge processes significantly decreased 72-hour return rates across a network of pediatric EDs and UCs.

Cardiac electrical stimulation is a rarely used but required skill for pediatric emergency physicians. Children who are in cardiac arrest or who demonstrate evidence of hypoperfusion because of cardiac reasons require rapid diagnosis and intervention to minimize patient morbidity and mortality. Both hospital- and community-based personnel must have sufficient access to, and knowledge of, appropriate equipment to provide potentially lifesaving defibrillation, cardioversion, or cardiac pacing. In this review, we will discuss the primary clinical indications for cardioelectrical stimulation in pediatric patients, including the use of automated external defibrillators, internal defibrillators, and pacemakers. We discuss the types of devices that are currently available, emergency management of internal defibrillation and pacemaker devices, and the role of advocacy in improving delivery of emergency cardiovascular care of pediatric patients in the community.

Quality improvement (QI) is a science of systematic analysis and improvement of health care delivery systems. Working knowledge of QI models is imperative to professional development of future pediatric emergency medicine practitioners. The Accreditation Council for Graduate Medical Education has established a list of QI and patient safety expectations for trainees. In order to address educational needs in this area, we have created a novel QI curriculum for pediatric emergency medicine fellows that include didactic sessions, active participation in QI projects, and mentorship by QI faculty. As a part of the curriculum, fellows are required to participate in variety of QI and patient safety activities, such as Morbidity and Mortality conferences, QI and Patient Case Review committees, and Clinical Care Guideline work groups. As a measure of success, fellows who have participated in this curriculum have shared their successful QI work at the local and national levels. This goal of this report is to share our experience in order to provide other institutions a framework for their own curriculum development.

OBJECTIVES:Evidence supports using dexamethasone for mild-to-moderate asthma exacerbations in the emergency department, but the effectiveness of dexamethasone versus prednisone for asthmatic patients who are hospitalized is unclear. Our aim was to compare outcomes for inpatients before and after our emergency department's adoption of dexamethasone for the treatment of acute asthma exacerbations.METHODS:In this single-center retrospective cohort study, we employed interrupted time series analyses to control for secular trends while evaluating our outcomes of length of stay, total inflation-adjusted hospital charges, and ICU transfer rates for patients admitted with asthma.RESULTS:Data were analyzed over 36 months (January 2014-April 2017) and included 1015 subjects (606 in the preprotocol change [pre-PC] group and 409 in the postprotocol change [post-PC] group). In the pre-PC group, prednisone only was used in 96% of subjects. In the post-PC group, prednisone only was used in 7% of subjects, dexamethasone in 65% of subjects, and a combination of the 2 steroids in 28% of subjects. Controlling for other variables in the interrupted time series model, we found no significant immediate differences between the pre-PC and post-PC periods for the outcomes of length of stay (P = .68), total charges (P = .66), and ICU transfers (P = .98). The rate of ICU transfers was stable pre-PC and increased by 10% (95% confidence interval: 2%-19%) per month (odds ratio = 1.10; 95% confidence interval: 1.02-1.19; P = .02) in the post-PC period.CONCLUSIONS:After dexamethasone replaced prednisone as the most commonly prescribed steroid type for inpatients with asthma at our institution, we found no immediate changes in outcomes for asthmatic patients who were hospitalized but an upward trend in ICU transfers.

Background and Purpose: Asthma education in acute care setting may prevent return visits. However, delivery of asthma education is time consuming and does not occur consistent in acute care areas. The objective of this Quality Improvement project was to implement efficient asthma education for patients discharged from Emergency Department and Urgent Care sites. Project Aim: Improve delivery of asthma discharge education in Emergency Departments (ED) and Urgent Care (UC) sites by achieving 90% utilization of asthma action …

Background Bronchiolitis it the most common cause of hospitalization among infants less than a year at an estimated cost of 1.73 billion dollars annually in the US. The American Academy of Pediatrics published updated Clinical Practice Guideline (CPG) in 2014 which recommend against the routine use of bronchodilators, chest X-rays (CXR) or viral testing (RVP) in the care of children from 1 through 23 months of age with …

Emergency department (ED) visits and hospitalization are common, costly and the greatest disease burden to children with asthma. Admission rates for asthma vary substantially by site and ED provider. Disease heterogeneity and ED provider uncertainty surrounding likelihood of successful discharge contribute to potentially avoidable hospitalizations. New approaches to improve ED disposition decision-making could improve patient care and reduce waste associated with unnecessary hospitalizations. Several asthma severity scores and asthma prediction models have been evaluated for their ability to predict ED disposition for childhood asthma. Our objective is to review prior studies that modeled predictors of disposition outcomes for children treated in ED settings for acute asthma exacerbations.

This QI project was used to reduce unnecessary use in bronchiolitis at a free-standing children’s hospital and affiliated community hospitals by using novel QI tools and interventions. OBJECTIVES: The American Academy of Pediatrics published bronchiolitis clinical practice guidelines in 2014 recommending against the routine use of bronchodilators, chest radiographs, or respiratory viral testing in children with a clinical diagnosis of bronchiolitis. Our aim in this project was to align care with the American Academy of Pediatrics clinical practice guidelines by decreasing the overuse of these interventions. METHODS: This study included patients who were admitted to a non-ICU setting with a primary or secondary diagnosis of bronchiolitis. The team used a multidisciplinary kickoff event to understand the problem and develop interventions, including sharing provider-specific data and asking providers to sign a pledge to reduce use. We used a novel, real-time data dashboard to collect and analyze data. RESULTS: Special cause variation on control charts indicated improvement for all outcomes for inpatients during the intervention season. Pre- and postanalyses in which we compared baseline to intervention values for all admitted patients and patients who were discharged from the emergency department or urgent care revealed a significant reduction in the ordering of chest radiographs (from 22.7% to 13.6%; P ≤ .001), respiratory viral testing (from 12.5% to 9.8%; P = .001), and bronchodilators (from 17.5% to 10.3%; P = .001) without changes in balancing measures (eg, hospital readmission within 7 days [1.7% (preanalysis) and 1.0% (postanalysis); P = .21]) for bronchiolitis. CONCLUSIONS: This multidisciplinary improvement initiative resulted in a significant reduction in use for bronchiolitis care at our institution. Our approach, which included a novel, real-time data dashboard and interventions such as individual providers pledging to reduce use, may have the potential to reduce overuse in other settings and diseases.